Treatment strategy for guided tissue regeneration in combined endodontic-periodontal lesions: case report and review.

INTRODUCTION Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. METHODS Twenty-six cases from 14 articles involving the successful management of endodontic-periodontal lesions with concurrent regenerative procedures were reviewed. This article also presents successful treatment of an endodontic-periodontal combined lesion involving a grade II mesial furcation of a maxillary molar with root canal treatment and multiple regenerative procedures. RESULTS A treatment algorithm is outlined for the application of the guided tissue regeneration (GTR) in managing endodontic-periodontal combined lesion. This treatment algorithm consists of 4 phases: (1) presurgical phase (determining periodontal/regenerative prognosis), (2) endodontic phase, (3) periodontal surgical phase, and (4) post-GTR reevaluation protocol. CONCLUSIONS The proposed 4-phase treatment algorithm might provide a beneficial guideline in managing the endodontic-periodontal combined lesions.